Outline

Purpose: To examine possible gender differences in the long-term use of cardiovascular drugs after first acute myocardial infarction, taking into account the individual risk factor profile at entry into in-hospital cardiac rehabilitation.

Methods: Study subjects were 309 men and 201 women, aged 30 to 75, who were admitted to a cardiac rehabilitation clinic in Southern Bavaria about three weeks after first acute myocardial infarction. Drug prescription at discharge from acute coronary care and at the end of the 3 to 4 weeks of in-hospital cardiac rehabilitation was recorded during hospital stay. Regular drug use 18 months after discharge was assessed by standardized telephone interviews and self-administered questionnaires. Groups of drugs included in this analysis are antiplatelet drugs, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and lipid-lowering drugs.

Results: The proportions of men and women who were prescribed the different types of drugs at discharge from the rehabilitation clinic were as follows: antiplatelet drugs: men 99%, women 99%; beta-blockers: men 93%, women 91%; ACE inhibitors: men 65%, women 65%; lipid-lowering drugs: men 88%, women 95%. About 18 months after discharge from the cardiac rehabilitation clinic similar proportions of men and women reported regular use of antiplatelet drugs (95%), beta blockers (86%), ACE-inhibitors (65% and 72% respectively); lipid-lowering drugs (80% and 85%). After multivariable adjustment for age, socioeconomic status, severity of coronary heart disease, and cardiovascular co-morbidity at entry into rehabilitation, no statistically significant association was found between gender and the various types of cardiovascular drugs used in the follow-up. A tendency existed that women were more likely to be prescribed lipid-lowering drugs compared to men (OR 1.6; 95% CI 0.92-2,72) and less likely to be prescribed beta-blockers (OR 0,79; 95% CI: 0,44-1.42). The latter effect was more pronounced in younger age groups (under 60 years).

Conclusion: The results of this study indicate – among men and women – a high long-term use of recommended cardiovascular drugs after first myocardial infarction. The findings also suggest that the comprehensive care and counselling during in-hospital rehabilitation may increase long-term adherence to drug treatment and reduce gender differences in secondary prevention